Date: November 4, 2019
As residency interview scheduling continues to become more competitive due to application inflation and over-invitation, the GME community is looking for solutions. The process could certainly benefit from more insight, humanity, and, in some cases, sanity. And as candidates are perceived as being “glued to their smartphones” at “all hours of the day,” some solutions have postulated that the time of day at which invitations are sent could make a difference.
For instance, should candidates be invited during the early morning hours before clinical duties begin? Is it best to invite them during the evening hours so as not to interfere with educational activities? What about weekends? Or any other time, for that matter?
This blog post will provide the answer using our Thalamus-driven data from the last five years, encompassing over 100,000 candidates across 70 specialties and 1,000,000 data points in total. In our 2019-2020 Residency Program Interview Process Best Practices Guide, we address these items in greater detail along with our other best practices.
This blog post will focus specifically on the time of day. And with the clocks having just changed for daylight savings, it is rather TIMELY ?
There is no ideal time to invite applicants in bulk. There is no single time on any given day where a program can ensure that all candidates are available. Thus, releasing invitations in bulk will always result in some candidates being at a disadvantage.
Residency program positions fill as a function of the number of positions available and the number of candidates invited to fill those positions. If a program invites a number of applicants that is equal to or greater than the number of positions available, positions will fill quickly. Entire seasons can fill in less than five to ten minutes. This is based on supply and demand.
Currently, candidates recognize that positions may fill very quickly, so once an invite is received they will attempt to schedule as soon as possible. Knowing this, programs attempt to be as fair as possible. Many send out their invitations at once, in bulk, and at a single time of day, to give all candidates a “fair” chance. While showing good intentions, does this ever allow the process to be fair?
Let’s go through an entire “usual” day in medical education and find out.
8 am EST/7 am CST/6 am MST/5 am PST
Start of the day on the east coast. Early morning in the central time zone. Earlier in the mountain time zone. And on the west coast, only medical students pre-rounding on their surgical rotation are likely awake. If your program invites now, and many do, then there is an obvious bias against candidates as you move further west across the US.
11 am EST/10 am CST/9 am MST/8 am PST
Now the entire country is likely awake and most medical students are attending to some educational duties. Some will be on challenging rotations, some will be in cases in the OR and others will be on electives, taking a day off, traveling to attend another interview or one of many activities that any of us would do on a daily basis. Everyone is likely able to respond to an interview invitation in some capacity, but should educational duties be disrupted for the inevitable race to fill interview positions?
2 pm EST/1 pm CST/12 pm MST/11 am PST
Mid-afternoon on the east coast. Lunchtime for everyone else (give or take). Is now a good time to invite? Many program coordinators go to lunch at this hour as well. Should that precious lunch break be disrupted to schedule an interview? Is this good for wellness? Seems better, because no educational activities are disrupted. But what if there is a lunch lecture?
5 pm EST/4 pm CST/3 pm MST/2 pm PST
Close of business on the east coast. Sign out between teams is occurring, depending on the specialty. Central and Mountain time zones are wrapping up their daily tasks. Pacific time zone is getting into their groove for the afternoon. Activities remain quite varied across the country.
8 pm EST/7 pm CST/6 pm MST/5 pm PST
Nighttime on the east coast; medical students are spending time with their significant others and families. Alternatively, maybe they are staying late at the hospital to tend to a patient or doing a night shift. Central and Mountain time zones are likely stuck in traffic during rush hour or eating dinner. If a candidate receives an invite now, should they pull over to the side of the road and try to schedule an interview? (this happens more than it should). Should dinner be interrupted? The west coast is just wrapping up work for the day, so can the students respond as quickly through their smartphones as someone mere feet from their home computer on the east coast?
11 pm EST/10 pm CST/9 pm MST/8 pm PST
Bedtime on the east coast. Bedtime for the country in general, or at least the time where daily stresses should shut down so the candidates can focus on the next day. The west coast will soon hit this period as well.
2 am EST/1 am CST/12 am MST/11 pm PST
It’s late. Some candidates are up rescheduling/canceling interviews on interview scheduling software or by email (we know because of our site usage statistics). But the majority of folks are sleeping.
5 am EST/4 am CST/3 am MST/2 am PST
Nearly the entirety of the country is asleep.
But wait a second! What about Alaska, Hawaii and Puerto Rico? In fact, what about IMGs throughout the world? Invite during the day in the US and there is undoubtedly someone sleeping somewhere in the world. And this is why many students now have family or friends in other time zones watching their email accounts and waiting for interview invites to arrive.
I will say it again, there is never one standardized time that works well for all applicants!
But what if we announce when we will send invites? Or if programs release all interview spots at once?
Unfortunately this does not solve the problem either. If a program or specialty announces when invites are sent, candidates respond even faster (imagine how quickly a famous band sells out its concert tickets when it is announced they will go on sale at noon tomorrow). So, since no time was good before, now candidates that have a bias against them (for whatever reason) have an even smaller window to book an interview. Many will log on to the interview scheduling software sites and just keep clicking refresh until positions appear and then grab whatever spot is available (whether that fits into their schedule or not).
Now imagine an entire specialty releasing all invites at once. Multiply this problem out by the number of interviews a candidate gets. Ever try to book tickets to 30 concerts at once? It wouldn’t work well, and not surprisingly, it doesn’t work well for booking interviews either.
No, there are methods that work (and will be explained below). The fact of the matter is that there is never a single time or date that works well for all applicants. Last week, there was a raging wildfire devastating Northern California to the extent that planned blackouts occurred in efforts to slow its spread. As such, cell signals, internet signals and obviously power were all affected. There were definitely candidates whose ability to schedule an interview was impeded.
And this happens more than we realize. Students may be on the subway and have no internet signal. Candidates may be in the shower. Candidates may be caring for their children. Perhaps a relative is sick in the hospital. Maybe someone forgot to charge their cell phone and now their battery is dead. Anything is possible, and the possibilities are endless.
For myself, I got stuck in New York City during my interview process thanks to Hurricane Sandy. I had no cell signal, I had no internet, and there was no way out of Manhattan (all bridges, tunnels, and subways were closed). I missed three interviews that week, two of which were never rescheduled. And I was late to countless other invites (this was 2012, so most were done by email, which put me at a significant disadvantage to those not affected by the storm).
Thalamus was born out of this experience, along with those of my co-founder, a residency program director, whose program was equally affected by scheduling issues involving the hurricane. We built Thalamus not because we envisioned positions filling quickly, but rather to leverage online scheduling to provide candidates more flexibility to make adjustments to their schedule when life happens, when storms hit, when misfortune occurs, or any other outcome for which scheduling an interview would be tricky.
But can’t we just invite everyone in the evening?
No, and this is the unfortunate challenge. This year (2019) we have already had a residency program fill greater than 100 positions in less than three minutes at invited around 8pm EST!
And inviting in the morning is no better, as we saw the same occur for a program that sent out bulk invites at 7 am EST.
So then isn’t online scheduling THE CULPRIT for positions filling quickly?
No, technology is not the reason positions fill quickly. Inviting more candidates than available positions is why programs fill quickly (including the two mentioned above). Before online schedulers, emailed positions filled just as quickly. There was just less transparency in the process because all of the emails were sitting in a program coordinator’s inbox waiting to be tended to. So sometimes it would take three weeks before candidates would learn that all interview positions were full. And this was because their email arrived only a few moments after some of their applicant counterparts minutes after invites went out three weeks prior. Technology is aiding in schedules filling quickly and making this process more transparent, but demand overwhelming supply is what causes the problem.
Programs should invite candidates in waves at staggered times. Start with your most desired candidates first, whatever the metrics are by which you determine that. Send out invitations to this first group, which only accounts for a fraction of your total interview positions. Let them schedule over the next few days to weeks. Then invite a second wave. Repeat the process. Then invite a third wave, and so on and so forth until positions fill up.
This provides candidates with the greatest flexibility. If they are invited by another program, they can change their date or pick another that may have become more desirable.
Recruitment for each individual program does not occur in a vacuum. Candidates get many invites in many different cities throughout the US. A candidate is more likely to interview at your program if they have the flexibility to schedule and they can fit your interview in with others and/or optimize travel to save money. When your program sends invites relative to other programs can influence all of this (and will be the subject of a future blog).
Overall, there is overwhelming evidence that this is a far superior invitation strategy (especially when we review our internal Thalamus data). Programs that invite in waves over weeks have decreased cancellations, increased numbers of completed interviews, shorter waitlists, increased candidate satisfaction, and more.
And how quickly do these programs fill? Over several days or several weeks (depending on intervals between invites amongst waves). It is more humane. It is less of a race. It isn’t demanding that candidates choose one program over another purely based on availability or lack thereof. It is giving candidates what they deserve: the opportunity to interview at your program.
And it doesn’t introduce a bias against time zones because spots don’t fill immediately, meaning that candidates, wherever they are in the world, have time to schedule a date that works well for them during a time that is convenient for them. Those in a situation where they can not respond immediately are not so disadvantaged.
In fact, this removes bias in many things including internet speed, access to devices, availability of help from family and friends, and other socioeconomic disadvantages.
We as a profession owe it to our students and applicants to provide them the most humane process possible and this is what we are focusing on at Thalamus. I’ve been on the front lines and through the rat race. Most of our team has been through this process on one side or another. We believe that data is what will truly make this process fairer, and our data around interview schedules has shown that there never is an ideal time to send invites. But inviting in waves and giving candidates ample time to schedule does level the playing field, and this is a strategy that most programs could easily adopt and practice.
Want to learn more about what Thalamus is doing with data and how it can assist with graduate medical education? Please contact us at email@example.com or through the contact page on our website. Whether you are a specialty organization, GME office, residency or fellowship program, or applicant, we’re happy to discuss our upcoming solutions to innovate this process and make it better for all involved.
Jason Reminick, MD, MBA, MS, is the CEO and Founder of Thalamus. He is passionate about medical innovation, education, and technology. Jason is a published author with work featured in top journals including The Journal of Graduate Medical Education (JGME) and The Journal of the American Medical Association (JAMA). Formerly, Jason trained in the combined Pediatrics/Anesthesiology residency program at Stanford University with clinical interests in pediatric chronic pain management. He was recognized as a Physician of Tomorrow award recipient (2012) by the American Medical Association for his entrepreneurial and medical journalism pursuits. Trapped in NYC during Hurricane Sandy at the start of his residency application season, Jason and Thalamus Coming! Founder Dr. Suzie Karan, are committed to optimizing the application process for applicants and programs alike.
Thalamus is the premier cloud-based interview management platform designed specifically for application to Graduate Medical Education training programs. We are the experts in the residency and fellowship application processes. Learn more about Thalamus.
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